|Previous Section||Back to Table of Contents||Lords Hansard Home Page|
The point has also been well made that, however pure, kind and noble you are-and I have worked for years in the academic world, where the intellectually pure apparently multiply-you soon learn how to follow the money. The Bill will suggest ways of following the money, which is another great danger. People are very inventive, often for the best of motives and reasons.
I get fed up speaking about Scotland, but I have to say that the increase in expenditure on care at home in Scotland is not a mistake but a deliberate policy, because the Scottish Government have set out to meet the wishes of people, which are, if possible, to remain in their own home and to reduce the costs. One of the ways in which they are doing that is by making it more attractive to remain at home than to go into far more expensive residential and nursing-care accommodation. That is the reason for the shift in cost, and you can see that the cost of residential care has pretty well stabilised. To do that is quite an achievement, but it is being done because they are finding cheaper and more appropriate ways of providing care.
There is, however, a real lesson from Scotland here, and I think that this relates to the point that the noble Earl, Lord Howe, was making. Scotland has a divide between what you might call hotel or accommodation and care costs. The hotel or accommodation costs for those in residences are still means-tested. The picture of freedom and free supply of cash for everything is not the case. These costs are means-tested. They have ways of dividing them off from the actual costs of care, and in Scotland they make a contribution to the cost of care. So the danger to which he points-that such a division will be brought into place here in a way which distorts the system; it does not distort it in Scotland, it is deliberate-is real, and there is an example of how to do it.
Baroness Turner of Camden: I may be mistaken, but my recollection is that a number of years ago, there was a commission that made recommendations, and I think that my noble friend Lord Lipsey was a member of that commission. The majority recommendation was that nursing and personal care should be paid for, but that accommodation and care would-as already indicated-be subject to means-testing and so on. We now have a situation in which care costs and nursing costs are regarded as one, and I would agree with that.
When the commission first made its report, I was in favour of it; but the report was not fully accepted by the Government, and so we had the distinction made between nursing and personal care. I always thought that that was not a very good division to make, because it very often came to virtually the same thing. In Scotland it was not accepted, and I see from an article which recently appeared in the Times thatthe allegation that Scotland is not managing to meet that cost is said to be quite untrue, and that Scotland is in fact managing those costs quite well. If this is what is intended in this section of the Bill, I would certainly be in favour of that, because I never believed that there should be a split between nursing and personal care. I always thought that they were the same care costs. If that is to be eliminated in this clause of the Bill, then I would be all in favour of it.
Baroness Murphy: I would like to support what the noble Baroness, Lady Turner, has just said about that element. I absolutely agree that it has always been an absurdity that nursing and care costs, both of which are related to the way in which an individual is cared for, should be separated. Any move away from those artificial and ridiculous distinctions is to be welcomed. My anxiety about this clause is that we are unfortunately imposing new definitions with new trenches down which people can fall and new cliffs to fall over, making them ineligible. That adds to the difficulty. I agree with the main thrust of the thoughts of the noble Baroness, Lady Turner.
Lord Tunnicliffe: My Lords, this group of amendments deals, in one form or another, with the Bill's provision on what counts as care at home. However, each amendment addresses rather different aspects of the provision. I shall therefore begin by making some general points about this aspect of the Bill.
First, it is important, and has been an aspiration of this Government for a number of years, to support people in their own homes. That is what people tell us they want, and indeed it has been supported by the Audit Commission's report Under Pressure,which was published just last week. This report highlighted that there is a growing trend towards care at home which meets the needs of people who need care and is something to which local authorities should aspire. We recognise that there are different residential settings, however, so it is important to have a debate on what is classed as a person's home. We want to retain the flexibility in our definition to maintain the intention of the Bill, while recognising that different settings or models of care may emerge over the coming years-something which we all know will need to happen to meet the needs of our growing ageing population.
The intention that underlies the Bill is that people with the highest care needs should be supported to live at home. We have made the specific point in the Bill that it is important that those adults who are part of an adult placement scheme, living in a family, do not miss out on this opportunity. It is therefore important to make it explicit that, for the purposes of the Bill, such adults are to be considered as living at home. In our opinion, this is the only situation which is required to be excepted from the six-week restriction on free provision of personal care in accommodation where care is provided as an integral part of that accommodation.
In other situations, it should be clear that people are either living in accommodation where care is provided as an integral part of that accommodation-a residential care home-and are not eligible, or living at home and may qualify for free personal care.
Some people have sought to argue that a residential care home could re-badge itself as extra-care housing and enable its residents to have their care free of charge. This is not about residential care or re-badging. We have always made it clear that it is about people living in their own homes for longer. Residential care is not the same. In any case, as was debated in another place and made clear there, where providers seek to change the provision of their services, it is for the regulator, the Care Quality Commission, to ascertain that they meet the relevant registration criteria.
Others have argued that residential care is a cheaper option than helping people to live at home. However, the experience of many local authorities shows that appropriate interventions and support-the right housing, adaptations and equipment, including telecare-can help people to live at home at a lower cost than going into residential care. Indeed, as I said a little earlier, last week's report by the Audit Commission, Under Pressure, made these points most effectively and forcefully. Local authorities must invest in new models of care. It is no longer acceptable for them to invest in the same old models of care-home care and residential care-as they have in the past.
For some people, and at the right time, entry to residential care may well be the only option. We do not want to close off this option. However, the majority of people say that they want to stay in their homes for longer, and the provisions in the Bill will enable them
22 Feb 2010 : Column 858
However, I also recognise that while it is important that this Bill supports people to stay in their own homes for as long as possible in order to live more independent lives, this does not mean that every care activity needed to support them happens inside their own home. Sadly, there may of course be situations where somebody is not able to leave their own home at all. For others, however, having support in the community is beneficial and maximises their ability for independent living in their own home. The Bill supports that principle and does not seek to prevent this; on the contrary, we will develop guidance which reflects that as good practice. I will talk a little further about that when I discuss in detail the specific amendments in this group.
Amendment 7, in the name of the noble Lords, Lord Lipsey and Lord Warner, the noble Earl, Lord Howe, and the noble Baroness, Lady Murphy, is clearly a wrecking amendment. It wrecks the fundamental essence of the Bill by removing subsection (2), which is the linchpin of the Bill. To accept this amendment would prevent us being able to ensure that those in the highest need could receive free personal care at home for more than six weeks. This is clearly against the spirit of the Bill and should not be supported by anyone who supports the principles underlying this Bill. We therefore cannot accept this amendment and urge opposition to it.
The Bill is about specific help for a specific group of people: those in greatest need. I believe that my noble friend said earlier that it would help 280,000 people, as well as the 130,000 who will be helped by reablement. It is about doing this now. It is the first step of a total package. We have confidence in the estimates, and we have gone through the figures with ADASS.
The Bill is not the same as what is happening in Scotland. The other place has agreed to the basic concept. This House has given the Bill a Second Reading, which enclosed the basic concept, and I do not intend to participate in or respond to a further Second Reading debate at this point.
Amendment 8 would require that regulations specified every setting that was not considered to be a person's home for the purpose of provision of personal care, and therefore every setting of accommodation where the six-week restriction to provide free personal care would still apply. We consider that the proposed definition as set out in the Bill accurately describes and excludes
22 Feb 2010 : Column 859
Were we to specify the different settings that should be excluded, that could require numerous changes to regulations as the nature of service provision changes over time. That seems unnecessary and undesirable. We are encouraging councils to look to provide care in a wide range of settings to meet people's changing and longer-term needs. Where providers wish to be seen to change the provision of services to benefit from the provisions, it will be for the regulator, the Care Quality Commission, to ascertain that they meet the revised registration criteria. We are not willing to accept this amendment, as the proposed definition set out in the Bill is accurate. I therefore hope that the noble Earl, Lord Howe, will withdraw his amendment.
The Bill seeks to remove restrictions on existing powers and will allow us to require people with the highest needs living at home to be provided with free personal care indefinitely. Amendment 10 from the noble Lords, Lord Warner and Lord Lipsey, the noble Earl, Lord Howe, and the noble Baroness, Lady Murphy, seeks to make it clear in the Bill that personal care for people living in extra-care housing can potentially be required to be provided free indefinitely.
We believe that such an amendment is unnecessary. As the Bill already provides in new subsection (4D), a person should be considered to be living at home as long as they are not living in accommodation provided under Part 3 of the National Assistance Act 1948, or in accommodation where personal care is provided together with that accommodation. That definition of living at home would include a person living in extra-care accommodation, as it would be neither Part 3 accommodation nor accommodation where personal care was provided together with that accommodation. That is because in extra-care housing, care and accommodation are provided not together but under separate arrangements made by the individual.
We would certainly seek to encourage people who wish to stay and receive the care they need at home to consider extra-care housing, as well as other forms of supported living such as sheltered housing, because they allow individuals to continue living independently. Because this setting of accommodation is already adequately covered by the provisions of the Bill, I hope that the amendment will not be pressed.
The noble Baroness, Lady Murphy, brought out a series of predictions and potential downsides. We have committed to review this legislation after 12 to 18 months and in that review we will see whether those predictions turn out to be true, but we believe that the predictions that we have made on cost and on numbers served are sound and will be borne out by experience.
Amendment 13, tabled by the noble Baroness, Lady Barker, raises an important point: these provisions should seek to ensure that those living in their own home are supported to do so for longer. However, it is important to reflect on the fact that this does not necessarily mean, as I believe the noble Baroness wishes to indicate with this amendment, that all the
22 Feb 2010 : Column 860
We will ensure that this area is covered fully in the statutory guidance that we will be developing to provide support to local authorities. For that reason, I do not consider that this needs to be in the Bill. While I do not accept the noble Baroness's amendment and ask her not to press it, I very much agree and commit to taking forward its principle.
The noble Earl, Lord Howe, as ever, made interesting points about the Bill. He was particularly concerned about "gaming" and language. That is a fair point, but we believe that many of the issues will be resolved in the development of regulations and guidance. With regard to the issue of residential homes being re-badged, we have said that the Care Quality Commission will create a definition that will stop that happening. We believe that the legal dividing lines will be practical, although we cannot go further into why we believe that. If it proves useful to elaborate on that in a letter, I will certainly send him one.
The noble Baroness, Lady Gardner of Parkes, referred to the number of people who will be helped. As I said earlier, some 280,000 people will be helped with support at home and some 130,000 by reablement.
I hope that some of the comments that I have made will meet the points made by the noble Lord, Lord Sutherland. The noble Baroness, Lady Turner, was perhaps giving us an insight into the broader picture that will be revealed in the coming weeks when we publish the White Paper.
Baroness Masham of Ilton: My Lords, before the Minister finishes, I have one question. How is he going to make inflexible local authorities flexible?
Lord Tunnicliffe: My Lords, this is almost the centre of every debate that we have about how we deliver services. An awful lot of us here have served in both national government and local authorities. There is a perennial tension between, for example, local authorities and the health service. At the end of the day, we must believe in good will.
There has been some reference to this being an area where we have to develop consensual politics. Many of us have the same common belief that services delivered locally are a good thing, but nevertheless there has to be intrinsic equity between the delivery of those services. There will be tensions between what we specify nationally and how that is interpreted, but one hopes that in this new world of consensus which I think even the noble Earl, Lord Howe, has promised us, we will be able to solve those problems.
Baroness Murphy: My Lords, has there been any specific financial modelling on our Amendment 7 regarding the impact of the new funding systems on other service streams? We have heard a lot about the interrelationships between care funding modalities.
Lord Tunnicliffe: I do not believe that there has been specific modelling. My understanding is that the fragility of the assumption you would have to make to do the modelling would make that modelling a not particularly valuable exercise. If that is an incomplete answer, though, I will write to the noble Baroness setting it out more completely.
Lord Lipsey: My Lords, anybody listening to these debates might find them becoming increasingly surrealistic. There is a debate going on in this Committee between people with real depth of knowledge of this area-I include people like the noble Lord, Lord Sutherland, with whom I do not see altogether eye to eye, and also the noble Baronesses, Lady Turner, Lady Murphy and Lady Barker-and Ministers, doing their best to inject a show of conviction into reading out the notes prepared for them by their civil servants, who are themselves trying to inject a note of conviction into defending a policy that has been handed down to them by the Prime Minister and has no intellectual substance behind it, other than what they have managed to cobble together in the few months since he delivered his imprimatur.
That came out particularly in the remarks made by the Minister, in saying that this is about getting local authorities to invest in new models of care; it is unfair to expect him to be a great expert on long-term care and it is always great to see him on the Front Bench. Of course local authorities need to invest, and heavily, in new models of care, but the plain and simple fact of the matter is that they will not have the cash to do so, because they are spending it all on free care for the Prime Minister's targeted electoral group. That is the reality of the situation.
There is no point pursuing this argument further with the Government, save to say this. The Minister said that he was not going to have a Second Reading debate because the House of Commons voted in favour of this Bill. That is perfectly true, but since then, Nick Clegg, the leader of the Liberal Democrats, has this morning announced that they made a mistake in doing so. He has thought it through and-I give him great credit for this-he has changed his mind and is now against the Bill. I hope that he is not the only one. In view of these debates, I hope that before we get to Third Reading the Government themselves may think again about this Bill and see if we cannot yet make this a stepping stone on which a consensus reform could be built. I beg leave to withdraw my amendment.
The Parliamentary Under-Secretary of State, Ministry of Justice (Lord Bach): My Lords, with the leave of the House, I will now repeat a Statement made in another place by my right honourable friend the Lord Chancellor and Secretary of State for Justice.
"With permission, Mr Speaker, I should like to make a Statement on the release of prisoners under the early release scheme known as end of custody licence, or ECL.
This scheme will be brought to an end on 12 March this year. All prisoners who are eligible for release on ECL on or before 12 March will be so released. Prisoners who have as of today been formally notified, under form ECL3, of release dates under the scheme up to and including 9 April will also be released. No prisoners will be released on ECL from and including 10 April.
In the last 13 years the prison population has increased dramatically. When I became Home Secretary in May 1997, it stood at 60,335. The most recent published figure was 83,820 on 19 February. Predicting the prison population and matching places to meet demand has always been difficult and inevitably imprecise. I can certainly recall early release schemes on three separate occasions-in 1984, 1987 and 1991-when the Government of the day faced crises in handling pressures upon the prison population.
In June 2007, my predecessor as Justice Secretary, my right honourable and noble friend Lord Falconer, introduced ECL to manage temporary pressures upon the prison estate and to guarantee that prison places were available for all those sentenced to custody. The end of custody licence enabled prison governors, under existing prison rules, to release on licence, up to 18 days before the end of their sentence, offenders who had been given a determinate prison sentence of four weeks to four years. The scheme specifically excluded offenders convicted of serious violent crimes, sexual offences subject to registration requirements, those who had broken the terms of temporary release in the past and foreign national prisoners who would be subject to deportation at the end of their sentence. It was later amended to exclude anyone convicted of terrorism-related offences.
ECL was explicitly introduced as a temporary measure. I have always said that we would end it as soon as we could. I have always recognised that, while necessary as a temporary measure, it was inherently unsatisfactory and potentially damaging to public confidence in justice-confidence which is otherwise high, particularly in the light of falling crime. I have therefore told the House on a number of occasions that I would bring it to an end as soon as it was safe to do so. My right honourable friend the Prime Minister has underlined this, for example on 7 May 2008, when he said at Prime Minister's Questions: 'When we have built up the number of prison places ... to ... 86,000, we will make ... decisions on the right thing ... about early release'. We are now at that point, and we are there because we have worked hard to increase the capacity of the prison estate.
As a result, prisoners have not been held under Operation Safeguard in police cells since September 2008, nor in court cells since February 2008. The House will wish to compare this to 1991, when a total of nearly 376,000 nights were spent by prisoners in police cells or court cells.
|Next Section||Back to Table of Contents||Lords Hansard Home Page|